1. Copyright © 2008 Delmar Learning. All rights reserved. Unit 26 Nutritional Needs and Diet Modifications

2. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Spell and define terms. Define normal nutrition. List the essential nutrients. Name food groups and list foods included in each group. State liquids/foods allowed on basic facility diets.

3. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe purposes of the following diets: –Clear liquid –Full liquid –Soft

4. Copyright © 2008 Delmar Learning. All rights reserved. Objectives State the purpose of calorie counts and food intake studies. Define dysphagia and explain risks of this condition.

5. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe general care for the patient with dysphagia and swallowing problems. State purposes of therapeutic diets. List types of alternative nutrition.

6. Copyright © 2008 Delmar Learning. All rights reserved. Objectives Describe the nursing assistant actions when patients are unable to drink fluids independently.

7. Copyright © 2008 Delmar Learning. All rights reserved. Introduction Nutrition –Entire process by which the body takes in food for growth and repair and uses it to maintain health

8. Copyright © 2008 Delmar Learning. All rights reserved. Normal Nutrition Food is normally taken into the body through the mouth –The beginning of the digestive tract Digestion –Breaking down foods into substances used by body cells for nourishment –Essential nutrients

9. Copyright © 2008 Delmar Learning. All rights reserved. Essential Nutrients To be well nourished, we must eat foods that: –Supply heat and energy –Regulate body functions –Build and repair body tissue

10. Copyright © 2008 Delmar Learning. All rights reserved. Essential Nutrients Six essential nutrients: –Proteins –Carbohydrates –Fats –Minerals –Vitamins –Water

11. Copyright © 2008 Delmar Learning. All rights reserved. The Food Guide Pyramid USDA Food Guide Pyramid –Designed to be individualized to each person to maintain a healthy weight Refer to Figure 26–1 to review the six food groups and the familiar USDA Food Guide Pyramid

12. Copyright © 2008 Delmar Learning. All rights reserved. The Food Guide Pyramid In addition: –Each person may use a small number of discretionary calories –These are extra calories used to consume solid fats, added sugars, alcohol, or extra food from any group

13. Copyright © 2008 Delmar Learning. All rights reserved. The Food Guide Pyramid For most people: –Discretionary calorie allowance is between 100 and 300 calories daily

14. Copyright © 2008 Delmar Learning. All rights reserved. The Food Guide Pyramid

15. Copyright © 2008 Delmar Learning. All rights reserved. Water Water is an essential nutrient that is necessary to life A person can live only a few days without water

16. Copyright © 2008 Delmar Learning. All rights reserved. Water Water is necessary for all cellular functions in the body An adequate intake of fluids is required to replace fluids lost through urine, stool, sweat, and evaporation through skin

17. Copyright © 2008 Delmar Learning. All rights reserved. Water The normal adult intake of fluids –Should be two to three quarts a day

18. Copyright © 2008 Delmar Learning. All rights reserved. Water Offering liquids to patients frequently is important because: –Some patients cannot drink liquids without your help –Elderly patients have a decreased sense of thirst –Adequate fluid intake is necessary to prevent urinary problems and constipation

19. Copyright © 2008 Delmar Learning. All rights reserved. Basic Facility Diets Food served to patients in the health care facility is prepared by the dietary department –It includes the essential nutrients

20. Copyright © 2008 Delmar Learning. All rights reserved. Basic Facility Diets The way in which it is prepared and its consistency –Will depend on each individual patient’s condition and needs Sometimes very strict dietary control is needed

21. Copyright © 2008 Delmar Learning. All rights reserved. Regular Diet The regular-select or house diet is a normal or regular (unrestricted) diet –Based on the Food Guide Pyramid

22. Copyright © 2008 Delmar Learning. All rights reserved. Clear Liquid Diet Temporary diet because it is an inadequate diet Made up primarily of water and carbohydrates for energy It may be used postoperatively –Or when the patient has a condition such as nausea and vomiting

23. Copyright © 2008 Delmar Learning. All rights reserved. Full Liquid Diet Does supply nourishment –May be used for longer periods of time than the clear liquid diet

24. Copyright © 2008 Delmar Learning. All rights reserved. Soft Diet Usually follows the full liquid diet Although this diet nourishes the body, between-meal feedings are sometimes given to increase the calorie count.

25. Copyright © 2008 Delmar Learning. All rights reserved. Special Diets Planned to meet specific patient needs Patients may need special diets because of religious preferences or health needs

26. Copyright © 2008 Delmar Learning. All rights reserved. Religious Restrictions Religious practice requires changes in diet for some patients.

27. Copyright © 2008 Delmar Learning. All rights reserved. Therapeutic Diets Standard diets can be changed to conform to special dietary requirements For example –An order might be written for a low-sodium soft diet when a patient has ill-fitting dentures and heart disease

28. Copyright © 2008 Delmar Learning. All rights reserved. The Diabetic Diet Diet is an integral part of the therapy of the patient with diabetes mellitus The diet is nutritionally adequate Sometimes a proper diet is all that is needed to control the disease

29. Copyright © 2008 Delmar Learning. All rights reserved. Sodium-Restricted Diet Sodium-restricted diets may be ordered for patients with chronic renal failure and cardiovascular disease These diets are some of the most difficult diets to follow

30. Copyright © 2008 Delmar Learning. All rights reserved. Calorie-Restricted Diet As long as activity remains constant A person must take in approximately 500 calories a day less than usual to lose one pound

31. Copyright © 2008 Delmar Learning. All rights reserved. Low-Fat/Low-Cholesterol Diet Prescribed for patients who suffer from: –Vascular disease –Heart disease –Liver disease –Gallbladder disease –Those who have difficulty with fat metabolism

32. Copyright © 2008 Delmar Learning. All rights reserved. Mechanically Altered Diets Any diet may be mechanically altered This means that the consistency and texture of foods are modified –Making foods easier to chew and swallow

33. Copyright © 2008 Delmar Learning. All rights reserved. Mechanically Altered Diets Usually chopped to the texture of hamburger –Making it easier to swallow –Soft items, such as bread, are not modified

34. Copyright © 2008 Delmar Learning. All rights reserved. Mechanically Altered Diets Usually served to patients with dental or chewing problems, and those with missing teeth

35. Copyright © 2008 Delmar Learning. All rights reserved. Pureed Diet Blenderized until it is the consistency of pudding or baby food Given to patients who have dysphagia –At risk of aspiration

36. Copyright © 2008 Delmar Learning. All rights reserved. Pureed Diet The pureed food should not be watery If it is the proper consistency, a plastic spoon will stand upright without falling Make the meal as visually appealing as possible –Avoid referring to the pureed food items as baby food

37. Copyright © 2008 Delmar Learning. All rights reserved. Supplements and Nourishments Many patients receive a nutritional supplement or between-meal nourishments Supplements are ordered by the physician and have a definite therapeutic value

38. Copyright © 2008 Delmar Learning. All rights reserved. Supplements and Nourishments Nourishments are substantial food items given to patients to increase nutrient intake –Often planned and ordered by the facility dietitian –Sandwiches or pudding –Nutritious liquids, such as milkshakes

39. Copyright © 2008 Delmar Learning. All rights reserved. Snacks Planned and regularly given, or unplanned upon patient request Given to patients to prevent or eliminate hunger between meals

40. Copyright © 2008 Delmar Learning. All rights reserved. Calorie Counts and Food Intake Studies The physician or dietitian may order special food intake studies for a patient with special nutritional needs

41. Copyright © 2008 Delmar Learning. All rights reserved. Calorie Counts and Food Intake Studies The patient’s food intake is carefully recorded for a period of time, usually three days The food intake is analyzed for nutritional adequacy and number of calories consumed

42. Copyright © 2008 Delmar Learning. All rights reserved. Calorie Counts and Food Intake Studies The dietitian uses this information –To plan a diet to meet the patient’s special medical needs

43. Copyright © 2008 Delmar Learning. All rights reserved. Fluid Balance Balance between liquid intake and liquid output –We take in approximately 2 ½ quarts of fluid daily –Typical output equals about 2 ½ quarts daily

44. Copyright © 2008 Delmar Learning. All rights reserved. Recording Intake and Output An accurate recording of intake and output (I&O), or fluid taken in and given off by the body –Basic to the care of many patients Some patients have an order to force (encourage) fluids –While others have a fluid restriction

45. Copyright © 2008 Delmar Learning. All rights reserved. Recording Intake and Output A fluid restriction requires a physician order You will find information regarding whether to push or restrict fluids on the care plan

46. Copyright © 2008 Delmar Learning. All rights reserved. Changing Water It is important to provide fresh water for patients –Water is essential to life In all cases, you should know whether a patient is allowed ice or tap water and if water is to be especially encouraged

47. Copyright © 2008 Delmar Learning. All rights reserved. Sensory Problems Some patients have sensory problems affecting their appetites, such as problems with food: –Temperature –Smell –Taste –Hearing and vision

48. Copyright © 2008 Delmar Learning. All rights reserved. Sensory Problems Some patients have sensory problems affecting their appetites, such as problems with food: –Touch –Texture

49. Copyright © 2008 Delmar Learning. All rights reserved. Sensory Problems Presentation and attractiveness of food are especially important for patients –Whose smell, taste, and texture sensations are impaired

50. Copyright © 2008 Delmar Learning. All rights reserved. Mealtime Assistance for Patients Who Have Swallowing Problems Patients who have difficulty swallowing –May require one-to-one assistance –Prompting –Or supervision at meals

51. Copyright © 2008 Delmar Learning. All rights reserved. Foodborne Illness Hot foods must be served hot Cold foods must be served cold –If the food is off-temperature, pathogens may multiply, causing foodborne illness Follow all temperature and infection control precautions when passing trays

52. Copyright © 2008 Delmar Learning. All rights reserved. Documenting Meal Intake Accurate documentation of each patient’s meal intake is very important Keep diet clipboards and lists covered to protect the patients’ privacy

53. Copyright © 2008 Delmar Learning. All rights reserved. Total Parenteral Nutrition Total parenteral nutrition (TPN) –A technique in which high-density nutrients are introduced into a large vein –Such as the subclavian or the superior vena cava

54. Copyright © 2008 Delmar Learning. All rights reserved. Enteral Feedings Enteral feedings are administered by tube Many different types of tubes may be used for these feedings –Nurse or physician inserts the feeding tube

55. Copyright © 2008 Delmar Learning. All rights reserved. Enteral Feedings Specially prepared solutions contain all the nutrients required by the body Keep the patient’s head elevated when the feeding is infusing, and for an hour after meals